Can You Skip Your Newborn Baby’s Eye Ointment?

A lot of what happens in the delivery room and newborn nursery once your baby is born is routine.

Tragically, skipping some of this routine care, from a RhoGAM shot to the vitamin K shot and hepatitis B vaccine, is becoming standard for some anxious parents.

Some even want to skip getting the antibiotic ointment that is placed on their baby’s eyes that can help prevent ophthalmia neonatorum, which can lead to blindness.

Ophthalmia Neonatorum

Since we don’t usually think of pink eye (conjunctivitis) as a serious disease, it is likely hard to imagine that neonatal conjunctivitis (ophthalmia neonatorum) could lead to blindness. It does though – or did.

The main cause was Neisseria gonorrhoeae, a sexually transmitted infection that could be passed to a baby when they were born. Similarly, Chlamydia trachomatis can cause ophthalmia neonatorum.

That ophthalmia neonatorum could be prevented was first discovered by a German gynecologist in 1881. Dr. Carl Siegmund Franz Credé instilled a drop of silver nitrate into a newborn’s eyes immediately after they were born and this greatly decreased the rates of infections in babies born in his hospital.

Today, erythromycin ophthalmic ointment and povidone-iodine have largely replaced the use of silver nitrate for preventing ophthalmia neonatorum, but it works on the same principle – killing any bacteria that might cause neonatal conjunctivitis, especially those that cause blindness.

Can You Skip Your Newborn Baby’s Eye Ointment?

Why skip a treatment that can prevent your baby from getting an infection that can lead to blindness?

Since ophthalmia neonatorum is generally caused by gonorrhoea and chlamydia, most parents who think about skipping their baby’s eye ointment are likely fairly confident that they don’t have one of these sexually transmitted infections. And most of them will likely be right.

In fact, some countries, including Australia, the UK, Norway, Denmark, and Sweden, have stopped routine ophthalmia neonatorum prophylaxis. Some just treat those babies who are at high risk for infections, especially if they didn’t receive prenatal care or have a maternal history of STIs, etc.

In the United States, routine use of erythromycin 0.5% ophthalmic ointment within 24 hours of a baby’s birth for the prevention of ophthalmia neonatorum is still the standard of care. In fact, it is required by law in many states.

What are some of the issues to consider when thinking about skipping your baby’s eye ointment?

• the incidence of gonorrhoea and chlamydia have been increasing in recent years and it is very possible to have these STDs without obvious symptoms
• up to 30 to 50% of babies born to a mother with gonorrhoea or chlamydia will get neonatal conjunctivitis, even if they had a cesarean section
• not all pregnant women are routinely tested for gonorrhoea and chlamydia
• ophthalmia neonatorum caused by gonorrhoea or chlamydia can very quickly lead to permanent scarring and blindness
• ophthalmia neonatorum caused by gonorrhoea or chlamydia is not as easy to treat as routine pink eye, often requiring hospitalization and systemic antibiotics
• gonorrhoea and chlamydia aren’t the only bacteria that can cause severe neonatal conjunctivitis

Most importantly, if you are thinking about skipping your baby’s eye ointment, know that places that routinely stopped using eye ointment to prevent ophthalmia neonatorum often  saw an increased incidence of gonococcal ophthalmia, while rates remain very low in the United States.

“The annual figures for ON reported during the study period, under statutory health protection regulations, underestimated the actual occurrence of this disease by a very substantial amount.”

Dharmasena on Time trends in ophthalmia neonatorum and dacryocystitis of the newborn in England, 2000–2011: database study

And you are likely to get worried every time your baby has a little eye discharge or redness, just like parents who skip vaccines worry when their child has a fever or cough.

Since the eye ointment that is used is safe (erythromycin doesn’t cause the irritation that silver nitrate used to in the old days), why take the risk of an infection that can lead to blindness?

What to Know About Skipping Your Baby’s Eye Ointment

The use of erythromycin eye ointment after your baby is born can help to prevent a serious infection that can lead to blindness. Don’t skip it.

More on Skipping Your Baby’s Eye Ointment

• AAP –  Why you should say yes to the test: newborn procedures explained
• AAP – Erythromycin Ointment
• 5 Things Parents Think Their Baby Doesn’t Need (sometimes, they’re right)
• Treatment and prevention of ophthalmia neonatorum
• Ophthalmia neonatorum prophylaxis
• Ophthalmia Neonatorum
• Neonatal Conjunctivitis
• Do newborns really need that eye ointment?
• Evidence on: Erythromycin Eye Ointment for Newborns
• Is Crede’s prophylaxis for ophthalmia neonatorum still valid?
• Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum: Reaffirmation Recommendation Statement
• Can Breast Milk Cure My Child’s Eye Infection?
• Managing eye health in young children
• Study – Time trends in ophthalmia neonatorum and dacryocystitis of the newborn in England, 2000–2011: database study
• Study – Keeping an Eye on Chlamydia and Gonorrhea Conjunctivitis in Infants in the United States, 2010-2015.

Last Updated on April 22, 2018 by Vincent Iannelli, MD